Wall echo shadow sign (breast)

Case contributed by Dr Giorgio M Baratelli

Presentation

Presented with a painless lump in her left breast. The lump was first diagnosed during breastfeeding, 2 years earlier and was diagnosed to be a galactocele by percutaneous aspiration of thick milk. The lump did not disappear completely after two aspirations. At clinical examination, a mobile, painless, hard lump measuring 3 cm in diameter, with indistinct margins, is detected in the upper outer quadrant of the left breast. The lesion is easily movable and the skin over the mass is normal; in the axilla and further, no lymph nodes are palpable.

Patient Data

Age: 40
Gender: Female
Ultrasound

Ultrasound shows a 3 cm round mass, anteriorly outlined by two curvilinear parallel lines; the external line being hypoechoic and vascularized and the internal line is hyperechoic which produce a sharply well-defined shadow, obscuring details posterior to the mass.

Mammography

Mammography shows a halo sign that is a radiolucent ring surrounding a dense nodule.

The halo sign in mammography has long been considered a sign indicating a benign process. It is most frequently seen with cysts and fibroadenomas. However, it does not guarantee a benign process because It is also identified in malignant breast lesions. 

Pathology

Gross pathology and histology. 

Case Discussion

The ultrasonographic image of the breast lesion is similar to the wall echo shadow sign (WES), also known as the double-arc-shadow sign, usually described when the gallbladder lumen is filled with either multiple stones or one large stone.

An FNAC and an aspiration procedure performed showed only a few inflammatory cells.

The lump was surgically removed and the pathological examination of the lesion shows a true pseudocyst cavity, that is a cyst without epithelial lining, with a thick fibrous wall of dense collagen tissue containing many chronic inflammatory cells and giant cells.

The pathogenesis of the lesion is related to a chronic evolution of a galactocele with inflammatory process of the wall. The reported case is unique in the literature.

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Case information

rID: 57543
Published: 1st Jan 2018
Last edited: 9th Jan 2018
System: Breast
Inclusion in quiz mode: Excluded

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